Yamada Takumi, Murakami Yoshimasa, Yoshida Yukihiko, Okada Taro, Yoshida Naoki, Toyama Junji, Tsuboi Naoya, Inden Yasuya, Hirai Makoto, Murohara Toyoaki, McElderry Hugh T, Epstein Andrew E, Plumb Vance J, Kay G Neal
Cardiac Rhythm Management Laboratory, Division of Cardiovascular Diseases, University of Alabama at Birmingham, 1670 University Boulevard, 1530 Third Avenue S., Birmingham, AL 35294, USA.
Heart Rhythm. 2007 Oct;4(10):1284-91. doi: 10.1016/j.hrthm.2007.06.008. Epub 2007 Jun 16.
The left atrial appendage (LAA) is one of the major sources of focal atrial tachycardias (ATs).
The purpose of this study was to investigate the detailed electrophysiologic characteristics and catheter ablation of focal ATs originating from the LAA.
The study population consisted of 47 consecutive patients with 50 focal ATs originating from the left atrium (LA): LAA in 13, left pulmonary veins (PVs) in 14, right PVs in 12, and mitral annulus in 11. Programmed electrical stimulation and pharmacologic testing were performed to examine the mechanism of LAA AT. Left atriography was performed prior to radiofrequency ablation to identify the focus in the LAA.
The mechanism of LAA AT was automaticity in 11 and triggered activity in 2. The 13 LAA foci were located mainly at the LAA base: 11 on the medial side and 2 on the lateral side. Atrial activation sequences within the distal coronary sinus were helpful in differentiating these LAA foci. The criterion of a negative P wave in leads I and aVL indicating an LAA AT focus was associated with sensitivity of 92.3%, specificity 97.3%, positive predictive value 92.3%, and negative predictive value 97.3%. No complications occurred in any of the 13 patients. All 13 patients were free of atrial arrhythmias without any antiarrhythmic drugs during follow-up of 8 +/- 3 years.
LAA ATs have typical electrophysiologic and electrocardiographic characteristics that are helpful in guiding radiofrequency catheter ablation.
左心耳（LAA）是局灶性房性心动过速（AT）的主要起源部位之一。
本研究旨在探讨起源于LAA的局灶性AT的详细电生理特征及导管消融治疗。
研究对象为47例连续的患者，共50例起源于左心房（LA）的局灶性AT：13例起源于LAA，14例起源于左肺静脉（PVs），12例起源于右PVs，11例起源于二尖瓣环。进行程序电刺激和药物试验以研究LAA AT的机制。在射频消融术前进行左心房造影以确定LAA内的病灶。
11例LAA AT的机制为自律性，2例为触发活动。13个LAA病灶主要位于LAA底部：内侧11个，外侧2个。远端冠状窦内的心房激动顺序有助于区分这些LAA病灶。I导联和aVL导联P波倒置提示LAA AT病灶的标准，其敏感性为92.3%，特异性为97.3%，阳性预测值为92.3%，阴性预测值为97.3 %。13例患者均未发生并发症。在8±3年的随访期间，所有13例患者在未使用任何抗心律失常药物的情况下均未发生房性心律失常。
LAA AT具有典型的电生理和心电图特征，有助于指导射频导管消融。
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